Comparison of Two High‐Power Ablation Strategies for Typical Atrial Flutter: Acute and Long‐Term Outcome

BACKGROUND: Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability. OBJECTIVE: To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters. METHODS: This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed. RESULTS: Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (p = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups. CONCLUSION: High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.